Infection control in the dental office

Determining the psychometric properties of a written test to assess safe dental practice

INTRODUCTION

Safe practice in medicine and dentistry has been a global priority area in which large knowledge gaps are present.Patient safety strategies aim at preventing unintended damage to patients that can be caused by healthcare practitioners. One of the components of patient safety is safe clinical practice. Patient safety efforts will help in ensuring safe dental practice for early detection and limiting non-preventable errors.A valid and reliable instrument is required to assess the knowledge of dental students regarding patient safety.

OBJECTIVE

To determine the psychometric properties of a written test to assess safe dental practice in undergraduate dental students.

MATERIAL AND METHODS

A test comprising 42 multiple-choice questions of one-best type was administered to final year students (52) of a private dental college. Items were developed according to National Board of Medical Examiners item writing guidelines. The content of the test was determined in consultation with dental experts (either professor or associate professor). These experts had to assess each item on the test for language clarity as A: clear, B: ambiguous and relevance as 1: essential, 2: useful, not necessary, 3: not essential. Ethical approval was taken from the concerned dental college. Statistical analysis was done in SPSS V.25 in which descriptive analysis, item analysis and Cronbach's alpha were measured.

RESULT

The test scores had a reliability (calculated by Cronbach's alpha) of 0.722 before and 0.855 after removing 15 items.

CONCLUSION

A reliable and valid test was developed which will help to assess the knowledge of dental students regarding safe dental practice. This can guide medical educationist to develop or improve patient safety curriculum to ensure safe dental practice.

Knowledge, Attitudes, and Practices of Undergraduate Dental Students About Sterilization, Disinfection, and Infection Control: A Questionnaire-Based Study

BACKGROUND

The core of infection control in dental settings involves minimizing potential cross-infection risks between patients and from patients to other workers in health care. Infection control is important for promoting enhanced adherence to protocols through sterilization, disinfection, and infection control knowledge, attitudes, and practices (KAP) among undergraduate dental students.

MATERIALS AND METHODS

A cross-sectional survey among 222 undergraduates of Dental Students and Interns of the Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India, was conducted. KAP of participants related to sterilization and disinfection were assessed before and after educational lectures using a pre-fabricated questionnaire.

RESULTS

All 182 respondents considered the importance of sterilization and disinfection during the dental procedure. While 98.8% had adequate knowledge about isolation and immunization, only 3.8% were vaccinated against hepatitis B virus (HBV). They were perfect in hand hygiene compliance (100%) and awareness regarding autoclave sterilization stood at 78.8%. Mean KAP scores were 7.03 ± 1.39, 10.15 ± 1.40, and 9.

CONCLUSION

The undergraduate dental students showed a high level of awareness but wide gaps between practice and attitude of sterilization protocols. Therefore, there is a need for interventions that could bridge the theory-practice gap to improve adherence to infection control measures.

An Emphasis on Engineering Controls and Administrative Controls in the Prevention and Control of COVID-19 in an Orthodontic Setting: Thinking Beyond Tomorrow

Introduction: Most of the initial focus in handling COVID-19 had been based on avoiding exposure by refraining from rendering most treatments other than those considered an emergency or urgent. Post-lockdown, with the resumption of most activities, there has been concern over the possibility of transmission scenarios if sufficient care is not taken. The control and prevention of the spread of infections when elimination of exposure is not possible is chiefly achieved through the judicious use of engineering controls and administrative controls in a clinical setting in addition to the standard protocols and transmission-based protocols. True safety lies in being one step ahead. There have been mentions of the possibility that COVID-19 could be opportunistic airborne in its spread, in addition to being spread via saliva, droplets, and contaminated surfaces or objects.

Method: A literature search of PubMed, Google Scholar, Cochrane Library, and advisories released by such organizations as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), Ministry of Health and Family Welfare (MOFHW), European Centre for Disease Prevention and Control (ECDC), Chinese Center for Disease Control and Prevention (China CDC), American Dental Association (ADA), Canadian Dental Association (CDA), French National Dentists Association, Dental Council of Belgium, National Health Service, England (NHS UK), National Health Service Scotland (NHS Scotland), and International Society for Infectious Diseases (ISID) was performed, with search parameters aimed at gathering information pertaining to infection control and cross infection control in dental settings as related to orthodontics.

Result: There have been numerous articles and advisories published over the last 20 years, but the main focus has been on safe practices and to an extent on personal protective equipment, with relatively less emphasis on the need for respiratory protection by way of engineering controls and administrative controls. This review highlights the engineering and administrative controls that can be put into effect to make infection control and prevention much more effective.

Conclusion: Any health care facility must be able to prevent, contain, and control infections with no risk of nosocomial infections. For this, an assumption has to be made that every individual in a health care setting is either at risk or a risk, depending on whether the person is infected or not. Meticulous attention to stringent policies of hygiene and infection control and prevention, coupled with suitable supporting engineering and administrative controls, is to be made a standard way of life in such facilities.

Land Use Effects on Airborne Bacterial Communities Are Evident in Both Near-Surface and Higher-Altitude Air

Land use influences the composition of near-surface airborne bacterial communities, and bacteria can be transported through the atmosphere at global scales. The atmosphere mixes vertically, but rigorously assessing whether the effects of land use on atmospheric communities extends to higher altitudes requires examining communities from multiple altitudes collected at a stable location and timeframe. In this study, we collected near-surface (<2 m) and higher-altitude (150 m) air samples from three sites in an agricultural/developed location and a forested/undeveloped location. We used bacterial 16S rRNA amplicon sequencing to compare communities and predict functionality by altitude. Higher-altitude and near-surface communities did not differ in composition within each location. Communities collected above the undeveloped location were equally variable at both altitudes; higher-altitude samples from the developed location predominantly contained Firmicutes and were less variable than near-surface samples. We also compared airborne taxa to those present in soil and snow. Communities from higher-altitude samples above the developed location contained fewer overlapping taxa with soil and snow sources, and overlapping Operational Taxonomic Units (OTUs) among the three sources differed by location. Our results suggest that land use affects the composition of both near-surface and higher-altitude airborne bacterial communities and, therefore, may influence broad bacterial dispersal patterns. This small-scale pilot study provides a framework for simultaneously examining local and regional airborne microbial communities that can be applied to larger studies or studies using different types of samplers.

Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment

The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: "dentist" OR "oral health" AND "COVID-19" OR "SARS-CoV-2" OR "coronavirus-19". After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.

Detection of microbial aerosols in hospital wards and molecular identification and dissemination of drug resistance of Escherichia coli

Antibiotic-resistant bacteria (ARB) present a global public health problem. Microorganisms are the main cause of hospital-acquired infections, and the biological contamination of hospital environments can cause the outbreak of a series of infectious diseases. Therefore, it is very important to understand the spread of antibiotic-resistant bacteria in hospital environments. This study examines the concentrations of aerobic bacteria and E. coli in ward environments and the airborne transmission of bacterial drug resistance. The results show that the three wards examined have an average aerobic bacterial concentration of 132 CFU∙m^-3 and an average inhalable aerobic bacterial concentration of 73 CFU∙m^-3, with no significant difference (P > 0.05) among the three wards. All isolated E. coli showed multi-drug resistance to not only third-generation cephalosporin antibiotics, but also quinolones, aminoglycosides, and sulfonamides. Furthermore, 51 airborne E. coli strains isolated from the air in the three wards and the corridor were screened for ESBLs, and 12 (23.53%) were ESBL-positive. The drug-resistance gene of the 12 ESBL-positive strains was mainly TEM gene, and the detection rate was 66.67% (8/12). According to a homology analysis with PFGE, 100% homologous E. coli from the ward at 5 m and 10 m outside the ward in the corridor shared the same drug-resistance spectrum, which further proves that airborne E. coli carrying a drug-resistance gene spreads out of the ward through gas exchange. This leads to biological pollution inside, outside, and around the ward, which poses a direct threat to the health of patients, healthcare workers, and surrounding residents. It is also the main reason for the antibiotic resistance in the hospital environment. More attention should be paid to comprehensive hygiene management in the surrounding environment of hospitals.

Do exposures to aerosols pose a risk to dental professionals?

Background

Dental care professionals are exposed to aerosols from the oral cavity of patients containing several pathogenic microorganisms. Bioaerosols generated during dental treatment are a potential hazard to dental staff, and there have been growing concerns about their role in transmission of various airborne infections and about reducing the risk of contamination.

Aims

To investigate qualitatively and quantitatively the bacterial and fungal aerosols before and during clinical sessions in two dental offices compared with controls.

Methods

An extra-oral evacuator system was used to measure bacterial and fungal aerosols. Macroscopic and microscopic analysis of bacterial species and fungal strains was performed and strains of bacteria and fungi were identified based on their metabolic properties using biochemical tests.

Results

Thirty-three bioaerosol samples were obtained. Quantitative and qualitative evaluation showed that during treatment, there is a significant increase in airborne concentration of bacteria and fungi. The microflora included mainly gram-positive organisms (Staphylococcus epidermidis and Micrococcus spp.), gram-positive rod-shaped bacteria and those creating endospores as well as non-porous bacteria and mould fungi (Cladosporium and Penicillium).

Conclusions

Exposure to the microorganisms identified is not a significant occupational hazard for dental care professionals; however, evidence-based prevention measures are recommended.

Gingival manifestations of tuberculosis in pediatric patients: series of 4 cases

OBJECTIVE

The aim of the study was to evaluate the gingival manifestations of tuberculosis (TB) in the oral cavity in pediatric patients.

STUDY DESIGN

Four pediatric patients were enrolled in the study. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Four pediatric patients who presented with atypical gingival lesions were thoroughly examined for local and systemic signs and symptoms, and a detailed history was obtained. All relevant investigations led to a definitive diagnosis of oral tuberculous lesions. On the basis of the final diagnosis, antitubercular therapy (ATT) was started for all the pediatric patients, and outcomes were measured.

RESULTS

All 4 patients responded very well to the treatment, with complete resolution of the lesions within 6 months after the initiation of ATT.

CONCLUSIONS

Health care professionals should rule out TB as one of the differential diagnoses in pediatric patients with atypical gingival lesions. ATT is strongly recommended for the treatment of oral TB to achieve good clinical outcomes. Rapid molecular tests based on nucleic amplification should be utilized for the diagnosis of TB in children and also for extrapulmonary TB because they are much faster and reliable compared with conventional methods.

Educator and Student Hand Hygiene Adherence in Dental Schools: A Systematic Review and Meta-Analysis

Health professionals and their patients are subject to cross-contamination and potential exposure to harmful infectious diseases. A common form of cross-contamination is through dental procedures without proper instrument care and lack of hand hygiene. The aim of this systematic review was to evaluate the published research on the adherence of educators and students in academic dental institutions to hand hygiene procedures. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles collected in the Cochrane, LILACS, PubMed, Science Direct, Scopus, and Web of Science databases. The initial search identified 1,196 articles. Ultimately, three studies were included for qualitative synthesis and two for the meta-analysis. The three articles had similar characteristics of observational hand hygiene research involving educators and dental students. In all three, hand hygiene among dental students did not reach 50% of the total number of opportunities, which is a troubling result. Although the hand hygiene rate of educators was higher than that of dental students, these findings point to a need to further promote hand hygiene to future professionals to avoid cross-contamination between health professionals and patients.

Infection Control in the Dental Office

The goal of an infection control program is to provide a safe working environment for dental health care personnel and their patients. Practitioners can achieve this by adopting measures that reduce health care-associated infections among patients and occupational exposures among dental health care personnel. It is crucial for all dental practitioners to be up to date on current Centers for Disease Control and Prevention guidelines, equipment, and techniques for proper infection control. Continuous evaluation of infection control practices is important. Patients and dental providers should be confident that oral health care can be delivered and received in a safe manner.

Antimicrobial effects of ozonated water on the sanitization of dental instruments contaminated with E. coli, S. aureus, C. albicans, or the spores of B. atrophaeus

OBJECTIVES

Ozone has been used as an alternative method for the decontamination of water, food, equipment and instruments. The objective of this study was to evaluate the antimicrobial effects of ozonated water on the sanitization of dental instruments that were contaminated by Escherichia coli, Staphylococcus aureus, Candida albicans and the spores of Bacillus atrophaeus.

METHODS

A total of one hundred and twenty standardized samples of diamond dental burs were experimentally contaminated with E. coli (ATCC 25922), S. aureus (ATCC 6538) and C. albicans (ATCC 18804) and the spores of B. atrophaeus (ATCC 6633) for 30 min. After the contamination, the samples were exposed to ozonated water (10mg/L O(3)) for 10 or 30min. The control group was composed of samples that were exposed to distilled water for 30 min. After the exposure to the ozonated water, 0.1 mL aliquots were seeded onto BHI agar to count the colony-forming units per milliliter (CFU/mL) of E. coli, S. aureus, and B. atrophaeus. Sabouraud dextrose agar was used to count the CFU/mL of C. albicans. The results were subjected to an analysis of variance and the Tukey test.

RESULTS

For all of the microorganisms studied, the ozonated water reduced the number of CFU/mL after 10 and 30 min of sanitization, and this microbial reduction was dependent on the duration of the exposure to the ozonated water. E. coli exhibited the greatest reduction in CFU/mL (2.72-3.78 log) followed by S. aureus (2.14-3.19 log), C. albicans (1.44-2.14 log) and the spores of B. atrophaeus (1.01-1.98 log).

CONCLUSION

The ozonated water was effective in reducing the CFU of E. coli, S. aureus, C. albicans and B. atrophaeus spores, suggesting that ozonated water can be used for the sanitization of dental instruments.

Biossegurança e odontologia: crenças e atitudes de graduandos sobre o controle da infecção cruzada

Este estudo teve o objetivo de investigar as percepções de graduandos de Odontologia sobre a fidelidade às diretrizes de biossegurança e acerca do preservar-se. Nove questões abertas, que abordaram aspectos de interesse para o tema, foram aplicadas em entrevista com 14 acadêmicos, que realizavam atendimento odontológico de pacientes da Faculdade de Odontologia de Araraquara da Unesp. Utilizou-se a metodologia de pesquisa qualitativa e a estratégia metodológica para análise das entrevistas foi a Discurso do Sujeito Coletivo (DSC). Três figuras metodológicas foram obtidas, sendo ideias-centrais, expressões-chave e o DSC propriamente dito. A análise dos discursos permitiu avaliar a fala natural da coletividade. Verificou-se a adesão dos entrevistados aos protocolos de biossegurança, embora houvesse a queixa de que, na rotina diária, as precauções fossem negligenciadas por não serem muito práticas. Entre as medidas de proteção individual e coletiva, rotineiramente utilizadas, foram apontados o uso de Equipamento de Proteção Individual (EPI) e as barreiras protetoras, bem como as atividades de desinfecção e esterilização. O risco de contágio foi visto por alguns com pavor e por outros com total indiferença porque acreditavam ser algo do qual é possível de se ter controle por meio da adesão às precauções padrão. Entre as doenças de maior preocupação, a aids e as hepatites B e C foram as mais temidas. Diante do discurso obtido, salienta-se a necessidade de se aperfeiçoar as estratégias educacionais, com intuito de motivar a fiel adesão às normas de biossegurança, essenciais no trato de pacientes odontológicos.

Handling post-dental extraction patients: how to avoid trans-infection of blood-borne diseases

PURPOSE

The aim of this study is to assess the risks of cross infection after dental extraction. A systematic approach is proposed to prevent the risks of cross contamination and infection.

MATERIALS AND METHODS

A survey was conducted in which patients were asked when and where they disposed of the gauze pad applied to the socket in their mouth postoperatively and whether they had touched it at all before throwing it away.

RESULTS

Of the patients, 40% threw the gauze pad in the roads' litter bins and 9.33% threw it away in the practice's bathroom; half of the patients declared that they had touched the gauze pad with their bare hands before its final removal.

CONCLUSIONS

The danger of trans-infection of blood-borne diseases is evident, and a series of measures is proposed to control it. Proper patient education, use of alternative methods of stopping postoperative bleeding other than a gauze pad, appropriate scheduling of appointments of already infected patients, and widespread vaccinations are some such measures. Attention and critical evaluation of the case are necessary because the already existing policies and guidelines are always open to improvements.